<?xml version="1.0" encoding="UTF-8"?>
<xsl:stylesheet version="1.0"
	xmlns:xsl="http://www.w3.org/1999/XSL/Transform">
	<xsl:template match="/">
		<fo:root xmlns:fo="http://www.w3.org/1999/XSL/Format">
			<fo:layout-master-set>
				<fo:simple-page-master page-height="279mm"
					page-width="216mm" margin-top="10mm" margin-left="20mm"
					margin-right="20mm" margin-bottom="10mm" master-name="PageMaster">
					<fo:region-body margin-top="20mm" margin-left="1mm"
						margin-right="1mm" margin-bottom="20mm" background-image="res/bgconfidential.jpg"
						background-repeat="no-repeat" background-position-horizontal="left"
						background-position-vertical="top" />
					<fo:region-before background-color="#FFFFFF"
						extent="16mm" />
					<fo:region-after background-color="#FFFFFF" extent="16mm" />
				</fo:simple-page-master>
			</fo:layout-master-set>
			<fo:page-sequence initial-page-number="1"
				master-reference="PageMaster">
				<fo:static-content flow-name="xsl-region-before">
					<fo:block font-size="7pt">
						<fo:external-graphic src="servlet-context:/images/logo.jpg"
							content-height="12mm" />
						<fo:block space-before="1em" text-align="left"
							font-family="sans-serif" font-size="8pt" font-style="italic"
							color="#007694">Northern Hospital, 185
							Cooper Street
							Epping Victoria 3076
							Phone: 03 8405 8000
							Fax: 03 8405
							8524</fo:block>
					</fo:block>
				</fo:static-content>
				<fo:static-content flow-name="xsl-region-after">
					<fo:block font-size="8pt" text-align="center"
						space-after.conditionality="retain" space-after="0.1in">
						<fo:page-number />
					</fo:block>
					<fo:block text-align="center" font-family="sans-serif"
						font-size="8pt" font-style="italic" color="#007694">Northern Hospital, 185
						Cooper Street,
						Epping Victoria 3076, Phone: 03 8405 8000, Fax: 03
						8405 8524
					</fo:block>
				</fo:static-content>
				<fo:flow flow-name="xsl-region-body">
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Patient Information</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>First Name</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:value-of select="/patientInfo/firstName" />
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
                                    <fo:table-cell border-style="solid" border-width="0.2mm"
                                        padding="1mm" number-columns-spanned="1">
                                        <fo:block>Last Name</fo:block>
                                    </fo:table-cell>
                                    <fo:table-cell border-style="solid" border-width="0.2mm"
                                        padding="1mm" number-columns-spanned="1">
                                        <fo:block>
                                            <xsl:value-of select="/patientInfo/lastName" />
                                        </fo:block>
                                    </fo:table-cell>
                                </fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Date of Birth</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:value-of select="/patientInfo/dateOfBirth" />
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Distress Thermometer</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Patient Distress score</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>5.5</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Distress Thermometer completed by</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:value-of select="/patientInfo/distressThermometerCompletedBy" />
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>If Carer</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<xsl:choose>
											<xsl:when test="/patientInfo/ifCarer = 'Y'">
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black"> Yes </fo:block>
											</xsl:when>
											<xsl:otherwise>
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black"> No </fo:block>
												<fo:block margin-left="5pt">
												</fo:block>
											</xsl:otherwise>
										</xsl:choose>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Risk factor check list</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Younger than 55</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<xsl:choose>
											<xsl:when test="/patientInfo/youngerThan55 = 'Y'">
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black">Yes</fo:block>
											</xsl:when>
											<xsl:otherwise>
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black"> No </fo:block>
											</xsl:otherwise>
										</xsl:choose>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Carer of dependents </fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<xsl:choose>
											<xsl:when test="/patientInfo/careOfDependents = 'Y'">
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black">Yes</fo:block>
											</xsl:when>
											<xsl:otherwise>
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black"> No </fo:block>
											</xsl:otherwise>
										</xsl:choose>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Financial Problems</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<xsl:choose>
											<xsl:when test="/patientInfo/financialProblems = 'Y'">
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black">Yes</fo:block>
											</xsl:when>
											<xsl:otherwise>
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black"> No </fo:block>
												<fo:block margin-left="5pt">
												</fo:block>
											</xsl:otherwise>
										</xsl:choose>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>StressFull Life History</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<xsl:choose>
											<xsl:when test="/patientInfo/stressfullLifeHistory = 'Y'">
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black">Yes</fo:block>
											</xsl:when>
											<xsl:otherwise>
												<fo:block margin-left="3pt" font-family="sans-serif"
													font-style="italics" font-size="10pt" color="black"> No </fo:block>
											</xsl:otherwise>
										</xsl:choose>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Lacks social support</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:choose>
                                                <xsl:when test="/patientInfo/lackSocialSupport = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Previous psychic history</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:choose>
												<xsl:when test="/patientInfo/previousPsychHistory = 'Y'">
													<fo:block margin-left="3pt" font-family="sans-serif"
														font-style="italics" font-size="10pt" color="black"> Yes
													</fo:block>
												</xsl:when>
												<xsl:otherwise>
													<fo:block margin-left="3pt" font-family="sans-serif"
														font-style="italics" font-size="10pt" color="black"> No </fo:block>
													<fo:block margin-left="5pt">
													</fo:block>
												</xsl:otherwise>
											</xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>High Alchohol Drug intake</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:choose>
												<xsl:when test="/patientInfo/highAlcoholDrugIntake = 'Y'">
													<fo:block margin-left="3pt" font-family="sans-serif"
														font-style="italics" font-size="10pt" color="black"> Yes
													</fo:block>
												</xsl:when>
												<xsl:otherwise>
													<fo:block margin-left="3pt" font-family="sans-serif"
														font-style="italics" font-size="10pt" color="black"> No </fo:block>
													<fo:block margin-left="5pt">
													</fo:block>
												</xsl:otherwise>
											</xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Anxiety or Depression</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:choose>
                                                <xsl:when test="/patientInfo/anxietyOrDepression = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Female</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
											<xsl:choose>
                                                <xsl:when test="/patientInfo/maleOrFemale = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Practical Problems</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Younger than 55</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/youngerThan55 = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Carer of dependents </fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/carerOfDependents = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Financial Problems</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/finance = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Stressfull Life History</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/stressfullLifeHistory = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Lacks social support</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/lackSocialSupport = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Previous psychic history</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/previousPsychHistory = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>High Alchohol Drug intake</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/highAlcoholDrugIntake = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Anxiety or Depression</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/anxietyOrDepression = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Female</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/maleOrFemale = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="3em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Physical Problems</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Appearance</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/appearance = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Bathing/Dressing </fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
										<xsl:choose>
                                                <xsl:when test="/patientInfo/bathingOrDressing = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Breathing</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/breathing = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black">Yes</fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black">No</fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Changes in Urination</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/urination = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Constipation</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/constipation = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black">Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black">No</fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Diarrheoa</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/diarhoea = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Eating</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/eating = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Fatigue</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/fatigue = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Feeling Swollen</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/feelingSwollen = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Fevers</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/fevers = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Getting around</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/gettingAround = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Indigestion</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/indigestion = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Memory/Concentration</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/memoryConcentration = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Mouth Sores</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/mouthSores = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Family Problems</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Dealing with children</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/dealingWithChildren = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Dealing with partner</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/dealingWithPartner = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Ability to have children</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/abilityToHaveChildren = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Family health issues</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/familyHealthIssues = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Emotional Problems</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Depression</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
										<xsl:choose>
                                                <xsl:when test="/patientInfo/depression = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Fears</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/fears = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Actions from Screening</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Cultural Needs</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/culturalNeeds = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>List Problems</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-size="10pt"
											color="black">
											<xsl:value-of select="/patientInfo/problems" />
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Interpreter used</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/interpreterUsed = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Language used</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/language"/>
                                        </fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Summary of Patient Cancer Journey</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
										<xsl:value-of select="/patientInfo/cancerTumourStream"/>
										</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											Initial
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block><xsl:value-of select="/patientInfo/cancerStage"/></fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											Progressed
                                        </fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Location of Screening</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>
										<xsl:value-of select="/patientInfo/inOutPatient"/>
										</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/inPatientLoc"/>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>If Inpatient where?</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/outPatientLoc"/>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>If Outpatient where?</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/outPatientLoc"/>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Carer Needs</fo:block>
									</fo:table-cell>
								</fo:table-row>

								<!-- <fo:table-row text-align="left" background-color="#007694"> 
									<fo:table-cell number-columns-spanned="2" font-weight="bold"> <fo:block text-indent="2mm" 
									color="white" line-height="8mm">Location of Screening</fo:block> </fo:table-cell> 
									</fo:table-row> -->


								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Practical Needs</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/practicalNeeds = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Family needs</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/familyNeeds = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Emotional needs</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/emotionalNeeds = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Spiritual/Religous needs</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/spiritualReligousNeeds = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Physical needs</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/physicalNeeds = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">GP Follow Up</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>GP follow up to be actioned</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/gpFollowUp = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>List GP follow up</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/listGPFollowUp" />
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Faxed to GP</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block margin-left="5pt">
											<xsl:choose>
                                                <xsl:when test="/patientInfo/faxToGP = 'Y'">
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> Yes
                                                    </fo:block>
                                                </xsl:when>
                                                <xsl:otherwise>
                                                    <fo:block margin-left="3pt" font-family="sans-serif"
                                                        font-style="italics" font-size="10pt" color="black"> No </fo:block>
                                                    <fo:block margin-left="5pt">
                                                    </fo:block>
                                                </xsl:otherwise>
                                            </xsl:choose>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">External Referrals</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Referred to</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/referredTo"></xsl:value-of>
                                        </fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Contact details</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/contactDetails"/>
										</fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
					<fo:block space-before="1em">
						<fo:table font-family="sans-serif" font-size="10pt">
							<fo:table-column column-number="1" />
							<fo:table-column column-number="2" />
							<fo:table-body>
								<fo:table-row text-align="left" background-color="#007694">
									<fo:table-cell number-columns-spanned="2"
										font-weight="bold">
										<fo:block text-indent="2mm" color="white"
											line-height="8mm">Comments</fo:block>
									</fo:table-cell>
								</fo:table-row>
								<fo:table-row>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block>Comments</fo:block>
									</fo:table-cell>
									<fo:table-cell border-style="solid" border-width="0.2mm"
										padding="1mm" number-columns-spanned="1">
										<fo:block font-family="sans-serif" font-style="italics"
											font-size="10pt" color="black">
											<xsl:value-of select="/patientInfo/comments"/>
                                        </fo:block>
									</fo:table-cell>
								</fo:table-row>
							</fo:table-body>
						</fo:table>
					</fo:block>
				</fo:flow>
			</fo:page-sequence>
		</fo:root>
	</xsl:template>
</xsl:stylesheet>